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SweetSouthernLove ASN, BSN

Operating Room
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SweetSouthernLove has 3 years experience as a ASN, BSN and specializes in Operating Room.

SweetSouthernLove's Latest Activity

  1. SweetSouthernLove

    ICU to surgery center

    I come from an OR background, specifically cardiovascular/cardio-thoracic surgery. Outpatient vascular surgery with a salary sounds like a dream to me, but then again, I am a die-hard OR nurse. Outpatient surgery is just that, outpatient. You will have the most stable patients that are coming to surgery. You may also have a variety of surgical procedures that are quick to moderate in length, unlike lengthy vascular procedures that are often inpatient due to extensive comorbidities (TEVAR, bypasses etc.). No call for a specialty like this is practically unheard of. It is the reason I am no longer a CVOR nurse because your “on call-life” is usually very extensive and can cause you to be married to that job. So, in my eyes the pros and cons are: PROS: -SALARIED. Awesome. Period. -No on-call or working late (hopefully), and this will probably ebb and flow because there may be days where you leave early. Similar to a call schedule. Like say Monday you leave an hour early because you are done with surgery for the day and Friday you stay an hour late because products or people or whatever is running behind. This could be looked at as a negative if you are salaried. Again, you will learn your time management (turnover, case length, prepping the OR at the beginning of the day etc. etc). -Outpatient patients (the most stable surgical patient population) -Specialty – no learning multiple surgical specialties. You will hopefully learn your surgeons inside and out (preference cards are golden, make or take notes of these!) within a couple of months of being there. - No weekends, no holidays, no call. You have more of your life back..and if you have a family…or even if you don’t, this will eventually matter to you over time. Take advantage of these perks! CONS: -SURGEONS are like old baseball gloves, they generally don’t like change. They need to trust you to be competent. They are the captain of the OR, so do your best to always be attentive and always learning. They will be grouchy for awhile because you’re new and learning, which is totally normal. But if you learn their preferences and little idiosyncrasies they won’t want any other nurse doing their surgeries but you. -Very specialized – If you love vascular surgeries this can be a pro. But being well rounded inside of the inpatient surgical realm is also helpful, especially with outpatient surgery. -Outpatient surgery is usually fast paced: small, quick cases or moderate 1-2 hours max. This may not be the case with vascular, but this will include quick turnover times and constantly moving, but in a good way. I would say this is probably also a pro, considering what specialty you’re coming from. Personally, I loved outpatient surgery. I loved the pace, you will learn a lot. And changing specialties always gives me nausea and anxiety because it’s simply the unknown. So, I wish you the BEST of luck. Hopefully you’re going to love it!
  2. I would say this is appropriate to do as a new nurse until you grasp your own rhythm and time management. Then come in when it is time to clock in. Think of it as accelerated self-study. All nurses are different but we all have licenses to protect. The more you know about the life that you are responsible for in that half of your day the better everything runs and this is just my experience. I am not sure what unit you are working on or how much autonomy you have from your preceptor right now but taking time solo to look up all the unknowns of the day can put you at a great advantage. Usually there isn't much time between unit huddle, shift report/hand off before you are off to do your initial assessments and grab meds. If someone has a complicated pathological process going on you need to know it. Not through RN report but know the concept of the disease process and what is normal vs. abnormal. This is learning and gaining experience. Some nurses may know how much time they need to wrap their head around things, others may be super quick and are masters at their craft. If you can find the time to do this ON the clock, well by all means DO these things ON the clock. If not, and you find that you clock in and can't "research" adequately then you should find out how much time you do actually need to know things about your patients. This is important not only for you but the entire team caring for that patient on that day. During rounds you should be speaking for your patient as the bedside nurse, at least where I come from this is what occurs. A good thing you can practice with your preceptor is having he/she ask you what is going on with your patients for that day. So you both start off on the same page. Being a relatively new nurse would be the only reason I would agree with this situation. Things will happen during your shift where you may have to know a lot of information in just a short amount of time. Basically, this is a skill, like other nursing skills, and you are new so you can perfect it as you gain more experience.
  3. SweetSouthernLove

    CVOR: How many nurses to an OR?

    I have always had two RNs in my CVORs, which I feel benefits both the surgical staff and patients. I was curious if this is a common occurrence all over especially due to nursing shortages. We staff CVOR with 2 RNs, 2 scrubs, 1 PA/ARNP and this is the same way that call is set up as well. 2 RNs come in, 2 scrubs come in. It is the only way I have ever ran a CVOR, but again I have not worked in a facility where there was only 1 RN for this type of room. Now with that being said, I have done open AAA repairs alone with myself and one scrub and two surgeons and it was an on-call situation and CVOR was standby. They eventually wound up calling in a second circulator but that was because my call shift was about to end. I stayed and helped the relief but she would have been alone otherwise. Is there a protocol for this? Is it AORN standard to have 2 circulators? How do nurses feel about this?
  4. SweetSouthernLove

    How long was your hospital orientation for a prn ICU position?

    I would really scout and probe hiring recruiters, sometimes if you spend enough time talking with them they can adjust your orientation. I just was hired on as a PRN in the OR with the same problem as you and I got out of the week long orientation completely. You could ask for maybe an accelerated orientation? Like a one day campus orientation, EMR, your med access and pharmacy info and a tour of the place you will be actually working so you can get a locker or whatever else you need to set up with other staff. Again, I don't speak for all hospitals or all nurses, this is what I was able to work out with a recruiter. Some hospitals who are open to hiring traveling nurses often have stuff like this available for this reason as well. Hopefully you can get it! My 9-5 is a desk job as well and I wanted to keep my OR nursing skills sharp. Good luck!
  5. SweetSouthernLove

    New RN starting ED Residency in one month. Tips/Advice?

    Pray!.. No I am kidding! But no seriously..Listen to these lovely nurses and have some fun saving those lives! 🙂
  6. SweetSouthernLove

    Malpractice insurance

    As a regular staff nurse consistently caring for patients in a clinical setting I always carried personal nursing malpractice insurance. It ranges maybe $150-200/year and to me it is worth it. I was previously insured with Mercer Proliability and now I am insured with Nurses Service Organization (NSO) and they both provide about the same coverage. My patients aren't aware that I hold this coverage so I am not really sure what you mean as in regards of having "something to take." I keep this coverage even now when I do not work in the clinical setting much as I am currently PRN in an OR and work for an insurance company now. The bottom line is, employers may offer malpractice/liability, and if a claim is made against you it will be your employer they are working for, not you. This can be problematic for many reasons. Surprisingly, a large number of nurses do NOT carry this insurance when they should. It pays for a defense attorney and any settlement/judgment against the nurse. People insure their homes, cars, pets etc. but not their careers which is surprisingly odd considering most people live paycheck to paycheck and this coverage is dirt cheap compared to other insurance premiums. Please, do your research and educate yourself to the best of your ability. Sometimes insurance is tricky, but often times the employer has fine print regarding this type of insurance and how it protects you, as a nurse or a provider you have a right to look at this at anytime if you are employed with them and providing patient care. This type of situation also can be problematic for private practices, when providers move from one employer to another or have a gap in work history without what is called "tail coverage." It is best practice and recommended that nurses carry their own liability insurance policy if a claim of malpractice is made specifically against them. As a nurse who has worked both in insurance and in clinical and non-clinical areas of nursing, my recommendation would be to at least look at policies, try to find a reasonable one that fits your needs and never let it lapse, especially if you continue on in education. Best of luck.
  7. SweetSouthernLove

    Thinking of quitting my new job.

    First off, bless your heart for even considering to stay. But no, you should not. The fact that your manager tells you that she no longer trusts you and that you probably won't change is a huge red flag for how she is doing her job. The preceptor should be auditing your chart if you feel unsure of yourself, no matter how busy or whatever the preceptor thinks, they still need to do this because both of your licenses are on the line. I would quit this job immediately though and probably not even put in my two weeks because you are probably still in a 90 day probationary period. This is a terrible situation to be in but I wouldn't risk my license on a boss who has it out from me from the start. In the future, and I know you are new so you may not know what is the correct way to chart something, but find someone who does and drag them to your computer to confirm what you have charted is correct. I have had to do this to multiple people multiple times when I was a newb in a new hospital or unit, etc. etc. and they always say "well it's your license." Yes, it is my license and that is why I am trying to be as accurate as I know how to be. Also, under orientation you should be documenting in those charts as such. The primary assigned nurse should be the first person in that chart and you should be an orientee. I apologize for this happening to you but I really wouldn't want to work an environment where my boss didn't have my back and blatantly told me so. You worked hard for your license, if you leave now your boss won't even have to be your recommendation for somewhere else which is important to think about in the long term. Just go in her office and tell her that you tried the job out and you don't think it is any longer a good fit for you. Give your two weeks or whatever you feel is necessary and walk. You will be glad you did.
  8. SweetSouthernLove

    Med/Surg to OR? Help!

    Personally, I love 5 8's which is what we call it in the OR. The charting is straight forward, the EMAR/orders are straightforward and the best part about your shift is if you have questions your physician/surgical team is right there to clarify. On the other hand, you may have a sleeping patient but you will have your physician/surgical team who will depend on you for just about everything AND you will be the first person in their line of fire/cursing and blame if something isn't just so. There are just different stressors that you may have to get used to. You are orchestrating the entire OR from preop and PACU and even other areas like sterile supply, anesthesia assistance and sales/vendor reps during surgeries. I clock in at 0645 and I am in my car at 1515 LATEST. There is never staying late to chart for 2-4 hours afterwards unless you are doing some kind of outpatient cases, in which case I would say maybe 30 minutes or so just to double check everything and that is me saying that because I know nurses need to do this in order to CYA. Also, working a shift like 7-3 for example, your relief or call team should be there around 2:30-2:45 latest to get report and take over the surgery and this is precisely the purpose of call teams so if the chart or the work isn't complete, then you will report off to the oncoming/on-call surgical staff and at that point is when I would do a once over of my charting, but again, it isn't as tedious as Q2/Q4 head to toe assessments, PIE notes, etc. etc. on the floor. What type of hospital will depend a lot on how often you are utilized for call. Smaller hospitals generally (and I say this very loosely) don't have crazy cases going on in the middle of the night. But there ARE cases that are urgent/emergent and need to be in the OR, so when on call pack breakfast, lunch and dinner because you may have to work right through your shift without getting a chance to go home. For example, I work 7-3 but Billy Bob is here from 7-5 so my call wouldn't start until 5pm when he is to go home for the day because he isn't on call. At that point the OR would call me to come back to work and relieve him if surgery was expected to go past 5 and I would leave when the case was finished. If there is not a "late person" I would start my call right at the time my shift would end which would be 3pm. Also, just because they call once when you are on call doesn't mean they can't call you six times until you aren't on call anymore. I have been called back three times in the same call shift. Generally rule of thumb is expect longer days with big, trauma and teaching hospitals. These hospitals can run late cases, transplants, operate all hours of the day or night and increase your call if their department is short-staffed. I personally despised floor nursing because of what you are going through. I worked consecutive 12s just to get away from the hospital as much as I could. A fellow nurse always used to say this to me and I agree, "I will take my worst day in the OR over my best day on the floor anytime." Call is entirely different and being a floor nurse I am not sure how well versed you are about what it entails. You don't have resources readily available on-call like you do on a regular Monday morning. Consider it like a ghost town when you are on-call and that is how you will have to orchestrate your surgery for those shifts. 3 days and one weekend every two months is minimal call so just know your resources, where things are, how to get a hold of people and what to do in emergencies like MH/RRT/Codes and you should be fine. Weekend call is usually 48 hours starting from 7am Saturday to 7am Monday if you take the entire weekend. Best of luck.
  9. SweetSouthernLove

    Failed Accelerated BSN program

    Do it. You will be doing something in two years anyways. Focus on balance and time for yourself as well. Most of us have been right where you are as nursing students, nurses or in some other capacity in health care and that is what makes nurses so great. There is a great quote by Maya Angelou that I have posted in my office and it has been up since I encountered my own struggle so I will pass it on to you, "You may encounter many defeats, but you must not be defeated. In fact, it may be necessary to encounter the defeats, so you can know who you are, what you can rise from, and how you can still come out of it." Nursing is one of the most trusted professions because we don't give up on our patients and as a patient, that is exactly the kind of person you want on your side fighting for your health and your life.
  10. SweetSouthernLove

    FNP worth it for aesthetic/plastic surgery field

    It really all depends on what you want to do as an FNP. Do you want to work in the OR with the surgeon or in the clinic seeing these types of patients? As an FNP you will most likely do both and this is what I have seen at my facility. We have one FNP and one PA who have been with the same plastic surgeon for years. He has certain "block time" to operate during the week and they follow his patients pre/postoperatively as well as any other patients on that service. FNP is a good route, but you really need to be committed to it as it will be a big investment with both your finances, time, effort and emotions. I would think for awhile about what you want to really do in this field and plan things out financially based on what FNPs in this field make in your area and what you currently make now and weigh out the decision that way. The good thing about FNP school is that it isn't going anywhere :) Good luck.
  11. SweetSouthernLove

    In The Right?

    Good Morning All, As of late I have returned to allnurses to find solace in my specialty of nursing. Currently, I have been trying to adjust to a new job in a new hospital with new coworkers as well as new surgeons. Everything has been going well except for one particular surgeon who seems to always place his misdirected anger at me. I have worked with many surgeons during my time as an OR nurse, but this past week an instance occurred that really changed the way I feel when I walk into work. It was a pretty standard but quick case. At the field she made requests for the following regarding the tissue she had extracted from the site: 1 frozen specimen, 1 permanent specimen, and 1 culture with the following tests: Aerobic/Anaerobic, Fungal, and Viral. I put both specimen orders in and had a runner take the frozen, which the results were relayed from Micro to him in a timely fashion. The culture order is where all hell broke loose. I am still within my 90 days at this new facility and so I was with a preceptor. I wanted to make sure the culture order was entered correctly because we had a different process where I came from. She said she was unsure and asked me to call Micro and so I did. I got information from Micro to relay to the surgeon about that there needed to be specificity regarding the type of viral culture that he wanted as they do not offer a virology culture panel for tissue. When I explained this to the surgeon and asked what viruses he would like to test for he simply shouted "ALL VIRUSES." I again relayed the information to Micro thinking there must be some order that he wanted for this and that they would know what it was as I am new and my preceptor was also unsure. They again told me that there is no such type of order for this. So again, wanting to do right by my specimens/cultures AND patient I tried to clarify with him and he screamed in an irate manner in front of my preceptor and my coworkers that "we have discussed this twice, I want all viruses - how can I know what virus to test for if I don't know what the tissue could have?" and so I began my physical walk to Micro, and again, they said maybe there is an Add On order that he wants and to clarify, and that there is no way they can test for ALL viruses because it is simply not reasonable or practical. If she had an idea of what viruses he wanted then they could tell me what order to put in for the patient. At this point after exhausting all of my own options as a new nurse I finally went to my manager. She spent 10 minutes on the phone calling half a dozen employees trying to investigate the order that he might be talking about and again to no avail. Finally, he comes around the corner and she asks her to come into her office, where we are trying to get to the bottom of this and when questioned calmly by my manager he proceeds to scream "we have discussed this three times just cancel the order!" and he proceeds to talk about me down the hallway to anyone who will listen. My manager's door was ajar and I am sure if there were patients in holding, they heard the whole ordeal. This of course is not the first time this surgeon has snapped on me and proceeded to talk within hearing distance about me to other coworkers. I feel that this surgeon is undermining my ability to be a decent nurse and communicate properly regarding the needs of my patient. The patient had some questionable history and I felt it necessary to get to the bottom of it if an order like that existed so that all appropriate testing could be done, especially when the surgeon themselves have given a verbal order for this. I felt the surgeon was just extremely pissed off in general regarding my presence and the communication regarding the culture order was poor at best on his part. At no point did he tell me to cancel this order in the OR and that was only finally revealed in my bosses office after all the leg work I had done to investigate the matter, and then I felt the blame for being an inconvenience. I dread this particular surgeon because of her treatment towards me and I know that is a part of a job, but I really felt like I was verbally abused in that moment and I am worried that it will only get worse. I expressed my feelings to both my preceptor as well as my manager and my preceptor apologized for putting me in an awkward position for not handling the order as she has been there much longer and could have assisted me with the navigation but she was also unsure and agreed that how we handled it was best because now we know better. My manager expressed that this particular surgeon is "that way" with everyone, but I am with him 8-10 hours per day and I directly observe his behavior with others and then with me. I know I am new and I am trying my best, but I feel like I am being treated as incompetent and even blamed for just trying to do the correct thing and be an advocate for my patient. Is there anything I can do differently? I don't want to shy away from the surgeon or the cases as I am one of the primary nurses for this area and will most definitely have to work with her at some point in the future. I am just not sure how I will be able to communicate properly if this is how it will constantly play out. I am not off of my probationary period yet, but I just felt defeated and incompetent and it really has changed the way I feel.
  12. SweetSouthernLove

    Moderate Sedation Cert Needed?

    Hello All, I am curious on your thoughts about this little issue I am having. I currently work in an ambulatory surgery center doing fast-paced cases. Sometimes 8-12 per day. Short, quick hand, foot and scope (knee, shoulder, ankle) cases. When I was first hired on I did not know that I would be the RN pushing Versed and upon this knowledge I promptly asked my nurse manager if I needed a moderate sedation certification. Now I know every hospital is different, but if I am documenting that I give this medication to all my patients without this certification could I be held liable if I am ever deposed? I do have ACLS, but again, I would feel more comfortable with this cert. for peace of mind, but my hospital is not requiring it so they will not pay. What to do? I guess I am being a worry wart about it but it still urks me to death to have to do something that I feel like is ultimately the anesthesia provider's job. Often times we are communicating on who is giving the Versed. Sometimes its them..when they feel like it..and MOST of the time it is me. I am also hanging their ABX but that is a whole other urk..anyways..any advice would be super appreciated!
  13. SweetSouthernLove

    Walmart cashiers wearing gloves?

    I am personally more concerned with Walmart's blatant lack of ability to air condition their stores properly, especially in my area. To me, every time I walk inside a Walmart I feel like I am in an incubator of germs, waiting for something to start growing. Their "warehouse" vibe grosses me out. I shop at Target, where I shop in comfortable air conditioning and now bag my own products/groceries. No harm no foul.
  14. SweetSouthernLove

    HIPAA Violation, Fired

    I hate to be blunt about this but...you DID do the crime, now you have to do the time. You consciously went searching for this patient, asking for the chart, and relying on your "friendships" with coworkers as justification to violate a patient's privacy. And then, when you were in the same room as the patient you chose to seek out the chart for the information that YOU were curious about. To me this is a purely personal MO and I don't have much sympathy considering nurses have been terminated for much less. What you did was wrong, point blank. Would you want some random nurse who took care of you before you were transferred to another unit doing this to you? Please, whatever you do, refrain from doing this again.
  15. SweetSouthernLove

    Berry & Kohn's or Alexander's

    Alexander's is the bible. As Rose said, if you go to Periop101 they will have this and usually a surgical instrument book available for you to borrow because you will have an exam at the end over AORN content from the Periop101 course, that way you could see what you are buying before hand. I personally bought a copy of both after I used them, they are excellent resources. There are good pocket guides to the OR out there as well such as: Pocket Guide to the Operating Room / Edition 3 by Maxine A. Goldman | 97883612266 | Paperback | Barnes & Noble® The book in the link reviews the basics of what you need to be functional as a new nurse in the OR: positions for specific surgery, instrumentation needed, special medications, what to look out for, and a brief overview of the procedure itself. Again, Alexander's is the bible and is often used in conjunction with many hospital's policies/procedures in the OR in addition with AORN standards.
  16. SweetSouthernLove

    On call requirement-help needed

    At my facility, and yours is probably similar: The purpose of call is to be available to the hospital. They are paying you because you are being "engaged to wait" in the event that an urgent/emergent case is booked and they need staff. You are technically still working while on call because there are requirements that you must adhere to while you are on-call such as: no drinking, no medications that will alter your mental capacity, no trips that could take you out of call-back distance and no events that mandate you to stay the entire duration without being able to leave for work duty. There are people at my facility who live almost an hour a way from my hospital as well as people with very crappy reception even with signal boosters in their homes. They do two things: 1. Request a pager. This allows you two methods of communication and they can use either your phone or pager and increases your chances to be notified at the earliest possible convenience. 2. COMMUNICATE WITH THE OR FRONT DESK STAFF. I cannot stress this enough. Whoever runs the desk, notify them of your need for extra time to commute. Granted, try not to rely on this because it will not always be possible, but if the front desk staff knows youve spoken with them and need extra time, they will most likely pick up the phone and call you first because of your geographical location compared to your coworkers so you have more time. (Usually, they have a list of call staff and just go right down the line calling people. So they can make notes by your name to give you more heads up.) 3. Tell your boss everything. People appreciate honesty, and be pretty straightforward about it. In this field, it can be life or death as others have said, and they need to know you can be depended upon to take a patient at any time. If the boss is worth a crap, they will appreciate this forethought on your part. Express your concerns and just give a short run down about why. 4. Know all routes that lead to the hospital. Drive them every once in awhile so you know them like the back of your hand when you are in a rush. If you are rushing for time and need to be there immediately, don't forget to put your hazards on or you will get stopped and delay your OR. 5. Have scrubs and comfortable shoes in two places: your trunk (in case you can't return home) and beside your bed at night - so that if you're groggy and half asleep you wont be wasting time scrambling for this stuff. 6. Also, when they say 30-minute call back time, they mean commuting there, in the hospital, dressed in OR attire, behind the red line and ready to accept your patient to the OR room as Rose said. Not entirely commuting. Being on-call is an extension of your job requirements. At my hospital, if you don't show up for call or if you are considerably late and someone has to cover for you, you can be written up or fired. Some hospitals are more lax than others, but it can impact your performance evaluations and your references at other hospitals that require you to take call. With that being said, there are people who will make remarks about call who may have more experience with it than you do, such as "two drinks is fine and I can sober up on the way there" or "I can make it, I probably wont get called anyway" or "it was quiet/calm when I left..." don't give in to their bad habits. The simple fact about this is if you are called-in its generally for something that cannot wait and if you're not at the top of your game someone could die. Take it seriously.